This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, February 04, 2012

Weekly Overseas Health IT Links - 4th February, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

The WSJ Debate

As the U.S. invests billions of dollars to convert from paper-based medical records to electronic ones, has the time come to offer everyone a unique health-care identification number?

Proponents say universal patient identifiers, or UPIs, deserve a serious look because they are the most efficient way to connect patients to their medical data. They say UPIs not only facilitate information sharing among doctors and guard against needless medical errors, but may also offer a safety advantage in that health records would never again need to be stored alongside financial data like Social Security numbers. UPIs, they say, would both improve care and lower costs.

Privacy activists aren't buying it. They say that information from medical records already is routinely collected and sold for commercial gain without patient consent and that a health-care ID system would only encourage more of the same. The result, they say, will be more patients losing trust in the system and hiding things from their doctors, resulting in a deterioration in care. They agree that it's crucial to move medical records into the digital age. But they say it can be done without resorting to universal health IDs.

Developers in the US have created mobile applications which make use of public data to help detect, prevent, diagnose and treat cancer.

The Office of the National Coordinator for Health IT (ONC) launched a competition for developers last year asking them to submit applications that can help both patients and clinicians in the ‘cancer control continuum’.

The continuum has been used in the US since the 1970s to describe the various points in the cancer-care process. The ONC has selected two winners, both of which will each receive US $20,000.

Kaiser Permanente has made patient access to their electronic health records available via mobile computing devices.

A new, free app for Android devices is available on the Android Market. An iPhone app will be available in coming months, but a shortcut icon can be downloaded now via the Safari browser to home screens that will take patients directly to the a mobile-optimized version of the kp.org Web site.

Jim Molpus, for HealthLeaders Media , January 24, 2012

Maybe healthcare IT leaders spend a lot of time reading Socrates or Marx or Locke on the philosophy of human nature and whether we are doomed to repeat mistakes made throughout history, or whether we are free-willed creatures capable of charting our own course through existence.

Maybe these leaders are too busy putting a crank to recalcitrant vendors to pay much attention to the ethereal questions of change and inevitability. But it seems some healthcare information technology leaders are doomed by Sisyphean forces to make the same mistakes over and over again.

In more than a decade of covering this industry, HealthLeaders Media has talked to or surveyed hundreds of healthcare CIOs, CMIOs, physician leaders, nurse leaders and executives of all stripes on what makes HIT projects work and what makes them fail.

Some trends emerged to the point of boredom. In fact, I got so tired of reading case studies that praised the virtues of "getting physician buy-in" that I banned one earnest tech editor from using the term.

I don't want to get all hyperbolic about this, but the suddenness of the federal government's shutdown of cloud-based file storage provider Megaupload last week got me thinking about the possible implications for healthcare IT.

The government's seizure of Megaupload's servers, trapping the content of whatever files were stored there, sure threw cold water on a lot of free-Internet activists who thought they had engineered a grassroots legislative victory by halting passage of the Stop Online Piracy Act (SOPA) and the Protect Intellectual Property Act (PIPA).

What opponents of SOPA and PIPA feared—that the proposed new laws would enable the government to shutter websites at will without due process—is, ironically, exactly what it appears the government just did.

Was every file on Megaupload pirated? Were legitimate business records stored there? Health records? (Heaven forbid.)

It’s easy to make predictions about health IT for the year to come, but what if someone asked what your IT wishes were for 2012? What would you like to see happen most in the health IT space?

We asked Wendy Whittington, MD, a practicing pediatrician and chief medical officer of Anthelio Healthcare Solutions, to list her top 10 IT wishes for 2012. From interoperability to telehealth, Whittington outlined what she, and most of her peers, would hope to see come true during the upcoming year.

1.A greater emphasis placed on the federal health IT strategic plan. According to Whittington, healthcare professionals and government officials alike should be paying closer attention to federal health IT strategic plan, and she suggests a revision of sorts could be helpful. “I would like to see that become a working document that we’re constantly referring to,” she said. “One of our biggest problems is a document comes out and it’s good, but what’s happening in healthcare is changing – a document needs to constantly be tweaked.”

Long-term sustainability is one of the critical challenges facing health information exchange (HIE) initiatives. In its recent report, 2011 Report on Health Information Exchange: Sustainable HIE in a Changing Landscape, eHealth Initiative identified just 24 out of the 196 active HIEs around the country that categorized themselves as sustainable.

What is sustainability? There are many definitions, but generally when referring to HIEs we define sustainability as generating enough revenue through various service offerings – excluding grants and donations – to fund operations. Other non-financial attributes may also be associated with sustainability, not the least of which is broad stakeholder involvement and support.

How does an HIE become sustainable? It’s important for the HIE to have a business plan that defines and drives them to sustainability. It doesn’t just happen. In developing a business plan, the HIE leadership must work to understand what their customers value – what they want and need – and what they will pay for. The HIE must offer services for which there is a demand and for which the perceived value is greater than the price customers are expected to pay. It’s a simple concept, yet one that is often missed in HIE formation efforts.

While healthcare executive applaud the benefits that health information exchanges (HIEs) can provide--such as improving the quality of clinical reporting and the coordination of care among physicians--the high costs of participating in an HIE is still an impediment, according to a study from healthcare management consulting firm Beacon Partners.

The study, which relied on interviews with more than 200 healthcare C-suite executives, found that 41% of respondents consider high start-up costs and insufficient capital to support HIEs as their top concerns. Additionally, 38% of respondents said they have annual budgets for HIE development of less than $1 million, while 21% have no budget at all.

Physicians like numbers. Data, double-blind studies, peer-reviewed journal articles, evidence. And they clamor for scientific proof whether the issue is prescribing statins[1] to patients at risk for heart disease or whether the debate at hand is the value of e[2]lectronic health records systems[2], the pros and cons of email communication[3] between docs and patients, the benefits of e-prescribing[4], or the impact of m-health technologies on patient outcomes.

Show me any IT initiative that will affect a physician's workflow, schedule, paycheck, or liability risk and I'll show you a doctor who's calling for evidence that the rewards outweigh the risks.

And since m-health, e-health, connected health, telehealth and data-driven health (et al) are pretty much dead in the water without physician support, researchers are scrambling to deliver it.

The Journal of the American Medical Informatics Association recently published a flurry of such studies, including one that found using an automatic alert system in providers' EHR systems significantly increases the documentation of previously unknown patient problems[5]. Another found that poor EHR implementation can skew quality measures. A third found that some EHRs are lacking in adverse drug event detection[6]. And yet another said they're a good tool for identifying preventative services in order to avoid unnecessary procedures.

Diabetics soon may be able to test their glucose levels in their saliva, rather than pricking themselves to draw blood for testing.

Researchers at Brown University have created a biochip that can measure glucose levels in saliva with the same basic accuracy as blood tests, according to a paper published[1] the scientific journal Nano Letters. It's a significant achievement considering that glucose concentrations in saliva are 100 times lower than those in blood.

One of the critical challenges to the successful adoption of patient-centered healthcare is ensuring that the patient adheres to his or her medication requirements. This means taking the right mediation in the right dose at the right time, with the right outcomes.

The advent of mobile health technology, from SMS programs to interactive pillboxes to barcode scanning devices, gives physicians more power in assuring compliance. And with a lucrative market that not only includes physicians but also health plans, caregivers and large businesses, vendors are showing up on the doorstep with a wide array of new ideas.

Among them is Southborough, Mass.-based SentiCare, which re-introduced its PillStation at last year’s HIMSS11 conference in Orlando, Fla., after receiving FDA approval and is now deploying the telehealth solution on a national level.

Tripathi spelled out in a recent blog the details of the organization's breach, which involved the theft of an unencrypted laptop from an employee's car, The breach, which affected about 1,000 patients of the collaborative's physician group practice clients, cost almost $300,000 to resolve.

January 26, 2012 (Winnipeg, MB) - First Nation patients will benefit from better health and health care through information and communications technologies with the launch of the Mustimuhw cEMR (Community Electronic Medical Record), due to the hard work of the Assembly of Manitoba Chiefs, announced AMC Grand Chief Derek Nepinak.

Mustimuhw cEMR (community Electronic Medical Record) is a computer program that provides health professionals with quick access to secure patient information such as blood test results, medication history and allergies. Developed by First Nations to offer solutions designed around First Nation Health Centre needs, the Mustimuhw cEMR's goal is to establish compatibility with clinical EMR systems in nine First Nation communities, so patient information can be shared more easily amongst authorized care providers both on and off reserve.

Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology, predicts at least 100,000 providers will receive federal electronic health-record incentive payments by year's end.

Mostashari offered his prediction in a post on the ONC's Health IT Buzz blog. He isn't taking a giant leap of faith, given the explosive growth in the number of providers who have registered and been paid over the past three months under the two incentive programs authorized by the American Recovery and Reinvestment Act of 2009.
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The project aims to develop an effective and practical way to bring awareness and understanding to those in the clinical sector, helping them better secure and protect health information while using mobile devices, such as laptops, tablets and smartphones.

The ONC is in working with the HHS Office for Civil Rights (OCR) on the initiative.

Electronic health records can do more than identify which patients should be receiving preventive and other additional services. They can also help providers pinpoint who shouldn't receive care.

That's the upshot of a recent study published in the Journal of the American Medical Informatics Association. The researchers studied EHR data from clinics affiliated with Northwestern University to see if the data could flag and measure whether certain patients were receiving pap smears too frequently. Clinical guidelines recommend that women at low risk for cervical cancer be screened for the disease every three years; more frequent screening is only justified for those at high risk. The researchers used the EHR data to measure the screenings.

Recent studieshave found that patients are interested in accessing and sharing their health information online. The technology to make this possible exists, and several health systems are leading the way.

Just this week, Kaiser Permanente announced a new no-cost Android application that will allow about nine million Kaiser members to use their mobile phones to access diagnostic information, email their physicians, obtain lab results and order prescription refills. Meanwhile, the Department of Veterans Affairs' Blue Button initiative -- which allows veterans to download their health care claims data from VA's MyHealtheVet website -- has been expanded to members of TRICARE's military health plan and Medicare beneficiaries. It soon will be available to federal workers, retirees and their families.

WASHINGTON—America may be a technology-driven nation, but the health care system's conversion from paper to computerized records needs lots of work to get the bugs out, according to experts who spent months studying the issue.

Hospitals and doctors' offices increasingly are going digital, the Bipartisan Policy Center says in a report released Friday. But there's been little progress getting the computer systems to talk to one another, exchanging data the way financial companies do.

"The level of health information exchange in the U.S. is extremely low," the report says.

At the consumer level, few people maintain a personal health record on their laptop or electronic tablet, partly due to concerns about privacy, security and accuracy that the government hasn't resolved.

Aligning financial incentives with high-quality care and accelerating health information exchange efforts (HIE) were among several key recommendations made in a new report[1] released this morning by the Bipartisan Policy Center (BPC) that focuses on health IT's role in transforming healthcare. According to former Senate Majority Leader Bill Frist, who co-chaired a BPC task force on delivery system reform and health IT, health innovation service delivery is severely lacking today despite significant advances in healthcare technology.

"Today's challenges aren't that much different than they were 25 years ago," Frist said at a BPC event unveiling the report's findings in Washington, D.C., this morning. "They're just much worse now."

Isabel Healthcare and BMJ Group have joined forces to create a new decision support tool for physicians. The application, known as Isabel with Best Practice, integrates Isabel's diagnosis decision aid--which emphasizes rare conditions that physicians often overlook--with BMJ Best Practice's evidence-based disease monographs.

When clinicians enter a patient's signs and symptoms, Isabel with Best Practice generates a checklist of potential diagnoses. After doctors select a diagnosis, they go into the Best Practice monographs. Those monographs provide information on other important symptoms, as well as first and second line tests, to help pinpoint the diagnosis. Treatment guidelines also are provided.

Drchrono, a startup that simplifies the professional lives of doctors by bringing electronic health records and much more to the iPad, has raised $2.8 million in funding led by Yuri Milner, with Google’s Matt Cutts and other investors participating. The startup had previously raised $1.3 million in seed funding from Milner, General Catalyst, Charles River Ventures, 500 Startups, Gmail creator and FriendFeed cofounder Paul Buchheit, Cutts, and the Start Fund.

Y Combinator-backed drchrono streamlines the professional lives of doctors and medical professionals by bringing electronic health records and much more to the iPad. The free iPad app allows doctors to schedule patient appointments, dictate notes via audio, take pictures, write prescriptions and send them to pharmacies, enable reminders, take clinical notes, access lab results, and input electronic health records.

WASHINGTON--The Office of the National Coordinator for Health IT announced its latest developer challenge for an application to ensure that patients make an appointment with their primary care provider when they return home from a hospital stay.

It is the latest effort by ONC to connect various tools to coordinate care as part of the meaningful use of electronic health records (EHRs) and other health IT and to promote better individual health, population health and lower costs.

Smartphones and tablets are transforming the future of health care. Can we really trust them to save lives?

The average auto refractor--that clunky-looking device eye doctors use to pinpoint your prescription--weighs about 40 pounds, costs $10,000, and is virtually impossible to find in a rural village in the developing world. As a result, some half a billion people are living with vision problems, which make it tough to read and work.

Ramesh Raskar knew fixing this problem would be tricky. It required a new way of thinking about eye tests--and a new kind of device, one powerful enough to support high-resolution visuals, cheap enough to scale, and simple enough to be used by just about anyone. The MIT professor briefly toyed with stand-alone options, which were complicated and costly. Then he reached into his pocket and pulled out an unexpected savior: his iPhone.

GE Healthcare is discontinuing a Web-based ambulatory electronic health record (EHR) product it purchased less than two years ago.

The Waukesha, Wis.-based healthcare division of General Electric Co. this week informed customers of the GE Centricity Advance EHR that the company will no longer support the product after June 30. GE Healthcare instead will offer upgrades to its flagship GE Centricity Practice Solution, a combined EHR and practice management system, for approximately the same price as Centricity Advance.

It's not just medical students who love their smartphones and tablets. Nursing students are catching up fast when it comes to using technology, according to a New York Timesarticle[1] this week.

Nursing students at some schools now use sophisticated simulation mannequins--rather than live patients--to hone their skills, the Times reported, something they likely should expect to do more of as they move into the real world, given efforts like the Veterans Health Administration's[2] SimLEARN program.

No question that kind of data breach--and the negative publicity that goes along with it--is a CEO's nightmare. But UCLAHS CEO David Feinberg, M.D., sees the positives in the situation. He tells HealthLeaders magazine that the experience was a wake-up call for the health system.

In 2011, more than 80% of adults reported using the Internet as a resource for health care quality information. As a result, consumers are becoming increasingly health literate and are able to understand health analytics comparing provider performance. The 2007 Health Information National Trends Survey found that 34% of surveyed consumers used Web-based tools to make hospital and physician selections.

Based on these trends, many health system websites have begun to include tools and information for patients and visitors that are designed to create a positive organizational image and provide more useful information. In so doing, hospitals increasingly are seeking to take on the role of trusted adviser that is closely aligned with the accountable care organization model being promoted through the health reform law.

ST. LOUIS – A new case study shows how Mercy healthcare system has reaped the benefits of integrating GS1 Standards, including bar codes, across the medical device supply chain.

The study, "Perfect Order and Beyond," describes how these standards were implemented in the clinical care setting (from manufacturing plant to patient bedside), driving supply chain optimization and enhancements to patient safety initiatives.

GS1 Standards are global standards and solutions to improve the efficiency and visibility of supply and demand chains across multiple sectors. GS1 barcode data on products can eliminate errors and allow healthcare providers and manufacturers to speak the same language with this improved data tracking process.